Impact on Outcome of Additional Microvascular Anastomosis—Supercharge—on Colon Interposition for Esophageal Replacement: Comparative and Multivariate Analysis

Fujita, Hiromasa; Yamana, Hideaki; Sueyoshi, Susumu; Shima, Ichiro; Fujii, Teruhiko; Shirouzu, Kazuo; Inoue, Yoshio; Kiyokawa, Kensuke; Tanabe, Hiroko; Tai, Yosiaki; Inutsuka, Hiroki

doi:10.1007/s002689900339

Cited by 65 publications

(66 citation statements)

References 11 publications

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“…Many surgeons recommend to associate this procedure to the substernal esophageal reconstruction [3][4][5][18][19][20][21][22]. Statistically our study has some bias.…”

Section: Discussionmentioning

confidence: 80%

Colonic Esophageal Reconstruction by Substernal Approach for Caustic Stricture: What is the Impact of the Enlargement of the Thoracic Inlet on Cervical Anastomotic Complications?

Boukerrouche¹

2014

Surgery

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Background: The two most commonly employed options for esophageal reconstruction are the posterior mediastinal route and the substernal route. Therefore, the biggest disadvantage of the retrosternal approach is the potential risk for compression of the graft at the site of the thoracic inlet. The purpose of this study is to report our results by analysing the impact of the enlargement of the thoracic inlet by removing the left half of manubrium and internal third of clavicle on the cervical anastomotic leakage. Methods:From 2005 to 2013, 82 left colonic interpositions for oesophageal caustic stricture were performed at our institution. There were 70 women and 12 men. Ten patients had a hypopharyngeal stricture that required also reconstructive surgery. Dilation was done in 56 patients.Results: An esophagocolic anastomosis was performed in 72 patients. A gastroenteroanastomosis was performed before reconstruction in 10 patients. A pharyngoplasty was associated in 10 patients. The thoracic inlet was enlarged in 35 patients .The colonic graft was anastomosed to the posterior surface of the stomach in 69 patients. The mortality rate was 2.43 %. Graft necrosis occurred in two patients. Cervical leakage was occurred in 25 patients. Eight patients developed a cervical structure. Statistical analysis revealed that the non-enlargement of the thoracic inlet was a predictive factor of cervical leak (OR; 3.63, CI; 1.06 -12.40, P= 0.039 ) .therefore the enlargement is associate with lower rate of cervical leak. The functional results were good. Conclusion:The non-enlargement of the thoracic inlet is a predisposing factor of cervical leak in substernal colonic interposition. Therefore the enlargement seems reduce the cervical leakage.

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“…Many surgeons recommend to associate this procedure to the substernal esophageal reconstruction [3][4][5][18][19][20][21][22]. Statistically our study has some bias.…”

Section: Discussionmentioning

confidence: 80%

Colonic Esophageal Reconstruction by Substernal Approach for Caustic Stricture: What is the Impact of the Enlargement of the Thoracic Inlet on Cervical Anastomotic Complications?

Boukerrouche¹

2014

Surgery

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“…Some other authors did not use the thoracic vessels for the hypervascularisation of the jejunum, but the external carotid artery and internal jugular vein by Carrel [28] or transverse cervical artery and the internal carotid vein [38,39] being taken. The latter vessels were preferred for the revascularisation of colonic graft too [40,41].…”

Section: Direct Revascularisation Of the Colonic Graft For Oesophageamentioning

confidence: 99%

Hypervascularisation of colonic graft for oesophageal replacement: literature review and own experience

Varabei¹,

Vizhynis²,

Makhmudov³

et al. 2017

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Colonic interposition in post-burn oesophageal strictures still remains a challenge. The main issue is the viability of the cervical portion of the colonic graft. The article provides a literature review on mesentericography and hypervascularisation of colonic graft for oesophageal replacement. The authors share their own experience. The study of the colic arterial anatomy enables one to choose its more perfused portion for oesophageal replacement. In insufficient blood supply, direct anastomoses with cervical or internal thoracic vessels have been proposed for hypervascularisation of the cervical part of graft. The technique of vessel ligation with a subsequent intensive collateral blood flow has been designed for hypervascularisation of the colonic graft. StreszczenieWstawka z okrężnicy w zwężeniach przełyku po oparzeniach nadal stanowi wyzwanie. Głównym problemem jest żywot-ność szyjnej części przeszczepu okrężnicy. W artykule przedstawiono przegląd piśmiennictwa dotyczącego mezenterikografii i hiperwaskularyzacji przeszczepu okrężnicy w celu odtworzenia przełyku. Autorzy przedstawiają także doświadczenia własne. Badanie anatomii tętnic okrężniczych pozwala na ich wybór do unaczynienia części okrężnicy zastępującej przełyk. W przypadku niedostatecznego dopływu krwi zaproponowano bezpośrednie zespolenie z naczyniami szyjnymi lub naczyniami piersiowymi wewnętrznymi w celu hiperwaskularyzacji szyjnej części wszczepu. Technika podwiązania naczyń z następczą intensyfikacją krążenia obocznego może być zastosowana również do poprawy unaczynienia części okrężnicy mającej zastąpić przełyk.

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“…Currently, we do it routinely in all patients undergoing a substernal colonic interposition. This associated procedure is recommended by many surgeons when using the substernal approach for esophageal reconstruction [34][35][36][37][38][39][40] . The cervical anastomotic leakage is the most common complication encountered in esophageal reconstruction.…”

Section: Choice Of Replacement Organsmentioning

confidence: 99%

15-year Personal Experience of Esophageal Reconstruction by Left Colic Arterydependent Colic Graft for Caustic Stricture: Surgical Technique and Postoperative Results

Boukerrouche

2016

Journal of Gastroenterology and Hepatology Research

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AIM: The aim of this retrospective study is to report a 15-year personal experience of surgical management of esophageal caustic stricture by using substernal left colic interposition. MATERIALS AND METHODS: From 1999 to 2014, 105 patients with esophageal caustic stenosis were managed surgically. There were 90 women and 15 men. Patients aged from 15 to 70 years. Emergency esophago-gastrectomy was performed in 4 patients. Early gastric stenosis was treated before reconstructive surgery by gastro-jejunostomy in 12 patients. Nutritional disorders were corrected before surgery. The thoracic inlet was enlarged in 36 patients. The functional results were evaluated in all patients. RESULTS: Postoperative death occurred in 3 patients. The complication rate was 26.6%. The transplant necrosis was occurred in 2 patients. Cervical anastomotic leakage occurred in 15 patients. Early reoperation was performed in 4 patients. Cervical anastomosis stricture occurred in 8 patients. The redundancy was occurred in 2 patients. The swallowing function was considered good in 94 patients (92.1%). CONCLUSION: The early endoscopic evaluation provides accurate diagnosis and permit to define an appropriate therapeutic strategy. The goal of esophageal reconstructive surgery is to restore digestive continuity and good swallowing function. The left colon graft based on left colic vessels and interposed by substernal route is the technique of choice to reconstruct the scarred esophagus with good results.

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Impact on Outcome of Additional Microvascular Anastomosis—Supercharge—on Colon Interposition for Esophageal Replacement: Comparative and Multivariate Analysis

Cited by 65 publications

References 11 publications

Colonic Esophageal Reconstruction by Substernal Approach for Caustic Stricture: What is the Impact of the Enlargement of the Thoracic Inlet on Cervical Anastomotic Complications?

Colonic Esophageal Reconstruction by Substernal Approach for Caustic Stricture: What is the Impact of the Enlargement of the Thoracic Inlet on Cervical Anastomotic Complications?

Hypervascularisation of colonic graft for oesophageal replacement: literature review and own experience

15-year Personal Experience of Esophageal Reconstruction by Left Colic Arterydependent Colic Graft for Caustic Stricture: Surgical Technique and Postoperative Results

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